Abstract
ObjectivesSexually transmitted infections (STIs) are associated with adverse outcomes in pregnancy, including mother-to-child HIV transmission. Yet there are limited data on the prevalence and correlates of STI in pregnant women by HIV status in low- and middle-income countries, where syndromic STI management is routine.MethodsBetween November 2017 and July 2018, we conducted a cross-sectional study of consecutive pregnant women making their first visit to a public sector antenatal clinic (ANC) in Cape Town. We interviewed women ≥18 years and tested them for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV) using Xpert assays (Cepheid, USA); results of syphilis serology came from routine testing records. We used multivariable logistic regression to identify correlates of STI in pregnancy.ResultsIn 242 women (median age 29 years [IQR = 24–34], median gestation 19 weeks [IQR = 14–24]) 44% were HIV-infected. Almost all reported vaginal sex during pregnancy (93%). Prevalence of any STI was 32%: 39% in HIV-infected women vs. 28% in HIV-uninfected women (p = 0.036). The most common infection was CT (20%) followed by TV (15%), then NG (5.8%). Of the 78 women diagnosed with a STI, 7 (9%) were identified and treated syndromically in ANC. Adjusting for age and gestational age, HIV-infection (aOR = 1.89; 95% CI = 1.02–3.67), being unmarried or not cohabiting with the fetus’ father (aOR = 2.19; 95% CI = 1.16–4.12), and having STI symptoms in the past three days (aOR = 6.60; 95% CI = 2.08–20.95) were associated with STI diagnosis.ConclusionWe found a high prevalence of treatable STIs in pregnancy among pregnant women, especially in HIV-infected women. Few women were identified and treated in pregnancy.
Highlights
An estimated 357 million new cases of curable sexually transmitted infections (STIs) occur annually [1]
We interviewed women 18 years and tested them for Chlamydia trachomatis (CT), Neisseria gonorrhoea (NG) and Trichomonas vaginalis (TV) using Xpert assays (Cepheid, USA); results of syphilis serology came from routine testing records
Adjusting for age and gestational age, HIV-infection, being unmarried or not cohabiting with the fetus’ father
Summary
An estimated 357 million new cases of curable sexually transmitted infections (STIs) occur annually [1]. Curable STIs are associated with increased adverse pregnancy outcomes such as miscarriage, stillbirth, and preterm birth [3,4,5]. Untreated STIs in pregnancy are associated with adverse outcomes in the neonate such as conjunctivitis, pneumonia, sepsis and infant death [3]. Studies have shown that risk of adverse events in pregnancy and neonates is increased when co-infections of two organisms are present [4]. In HIV-infected women, STIs increase the risk of mother-to-child transmission (MTCT) of HIV in utero and intrapartum [6]. In a recent study of HIV-infected pregnant women, other STIs nearly doubled the risk of having an HIV-infected infant [7]. Several mechanisms linking STIs with HIV transmission have been studied. In HIV-uninfected women, STIs increase the risk of HIV acquisition [10, 11] and high viral load can significantly increase the risk of vertical HIV transmission [12]
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